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Disseminated cerebral toxoplasmosis in a patient with chronic lymphocytic leukemia.
J Clin Neurosci 2018; 50:127-128JC

Abstract

Infections are one of the most common causes of mortality in immunocompromised patients. In patients diagnosed with hematologic malignancies, treatment with stem cell transplants (SCT) or T-cell suppressing chemotherapy increases the risk of central nervous system (CNS) infections, of which toxoplasmosis is the most common. We report the case of a 63 year-old woman with chronic lymphocytic leukemia (CLL) that presented with gait instability and visual changes. Intracranial lesions were noted on initial neuro-imaging. A rapid decline in the patient's mental status warranted an urgent biopsy of the lesions that revealed tachyzoites consistent with toxoplasmosis. In the presence of diffuse brain lesions that lack a metastatic pattern or contrast enhancement, a common approach is to perform biopsy only after a battery of non-invasive testing. This diagnostic delay may take several days, exposing the patient to a rapidly fatal infection. This report illustrates the utility of early brain biopsy in high-risk patients with hematologic malignancies and CNS lesions.

Authors+Show Affiliations

Case Western Reserve Univerisity School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, United States.Case Western Reserve Univerisity School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, United States.Department of Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, 9600 Euclid Ave, Cleveland, OH 44195, United States.Department of Neurosurgery, Center for Neurological Restoration, Cleveland Clinic Foundation 9500 Euclid Ave, Cleveland, OH 44195, United States.Department of Neurology, Neurological Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates. Electronic address: kuruvij@ccf.org.Department of Infectious Disease, Respiratory Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, United States.Department of Neurosurgery, Center for Neurological Restoration, Cleveland Clinic Foundation 9500 Euclid Ave, Cleveland, OH 44195, United States.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29428267

Citation

Xu, Jordan, et al. "Disseminated Cerebral Toxoplasmosis in a Patient With Chronic Lymphocytic Leukemia." Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, vol. 50, 2018, pp. 127-128.
Xu J, Nault RJ, Maldonado-Naranjo A, et al. Disseminated cerebral toxoplasmosis in a patient with chronic lymphocytic leukemia. J Clin Neurosci. 2018;50:127-128.
Xu, J., Nault, R. J., Maldonado-Naranjo, A., Frizon, L. A., John, K., Holman, K., & Nagel, S. J. (2018). Disseminated cerebral toxoplasmosis in a patient with chronic lymphocytic leukemia. Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, 50, pp. 127-128. doi:10.1016/j.jocn.2018.01.057.
Xu J, et al. Disseminated Cerebral Toxoplasmosis in a Patient With Chronic Lymphocytic Leukemia. J Clin Neurosci. 2018;50:127-128. PubMed PMID: 29428267.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disseminated cerebral toxoplasmosis in a patient with chronic lymphocytic leukemia. AU - Xu,Jordan, AU - Nault,Rod J, AU - Maldonado-Naranjo,Andres, AU - Frizon,Leonardo A, AU - John,Kuruvilla, AU - Holman,Katherine, AU - Nagel,Sean J, Y1 - 2018/02/07/ PY - 2017/11/15/received PY - 2018/01/08/accepted PY - 2018/2/13/pubmed PY - 2018/7/28/medline PY - 2018/2/12/entrez KW - Chemotherapy KW - Disseminated cerebral toxoplasmosis KW - Immunosuppression KW - Leukemia SP - 127 EP - 128 JF - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia JO - J Clin Neurosci VL - 50 N2 - Infections are one of the most common causes of mortality in immunocompromised patients. In patients diagnosed with hematologic malignancies, treatment with stem cell transplants (SCT) or T-cell suppressing chemotherapy increases the risk of central nervous system (CNS) infections, of which toxoplasmosis is the most common. We report the case of a 63 year-old woman with chronic lymphocytic leukemia (CLL) that presented with gait instability and visual changes. Intracranial lesions were noted on initial neuro-imaging. A rapid decline in the patient's mental status warranted an urgent biopsy of the lesions that revealed tachyzoites consistent with toxoplasmosis. In the presence of diffuse brain lesions that lack a metastatic pattern or contrast enhancement, a common approach is to perform biopsy only after a battery of non-invasive testing. This diagnostic delay may take several days, exposing the patient to a rapidly fatal infection. This report illustrates the utility of early brain biopsy in high-risk patients with hematologic malignancies and CNS lesions. SN - 1532-2653 UR - https://www.unboundmedicine.com/medline/citation/29428267/Disseminated_cerebral_toxoplasmosis_in_a_patient_with_chronic_lymphocytic_leukemia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0967-5868(17)32010-6 DB - PRIME DP - Unbound Medicine ER -